New York State Seal
STATE OF NEW YORK
INSURANCE DEPARTMENT
25 BEAVER STREET
NEW YORK, NEW YORK 10004

George E. Pataki
Governor

Gregory V. Serio
Superintendent

The Office of General Counsel issued the following opinion on August 1, 2003 representing the position of the New York State Insurance Department.

RE: No-Fault Assignments for Durable Medical Equipment

Question Presented:

May an eligible injured person assign their rights to No-Fault reimbursement to a provider of durable medical equipment?

Conclusion:

Yes. Pursuant to the No-Fault Regulation 68, an assignment of benefits may be made to a provider of durable medical equipment.

Facts:

No specific facts were provided.

Analysis:

Pursuant to N.Y. Comp. Codes R. & Regs. tit. 11, § 65-3.11(a) (2002) (Regulation 68), "An insurer shall pay benefits for any element of loss…directly to the applicant…or, upon assignment by the applicant…shall pay benefits directly to providers of health care services as covered under section five thousand one hundred two (a)(1) of the Insurance Law…." This provision establishes that those providers of health services which are covered under N.Y. Ins. Law § 5102(a)(1)(McKinney 2003) may receive an assignment for reimbursement from an eligible injured person.

Section 5102(a)(1) enumerates particular health services that are reimbursable under No-Fault as "necessary expenses". Included in these enumerated services under Section 5102(a)(1)(I) are "prosthetic services". Necessary durable medical equipment provided are covered under this category.

When a provider of health services enumerated under Section 5102(a)(1) is given an assignment by an eligible injured person pursuant to Section 65-3.11(a) of the Regulation and therefore, as assignee, becomes the claimant for purposes of reimbursement for covered services, that assignee must adhere to all applicable New York State statutes which grant the authority to provide health services in New York State. If a locality requires licensing (such as in New York City, where the Department of Consumer Affairs requires sellers of durable medical supplies to be licensed) the assignee must be licensed in that jurisdiction in order to be reimbursed for services provided.

For further information you may contact Supervising Attorney Lawrence M. Fuchsberg at the New York City Office.